Medical and Surgical Cases: Sources and Methods

Susan C. Lawrence

All of the medical and surgical cases included in Civil War Washington were extracted from The Medical and Surgical History of the War of the Rebellion (1861–1865) (hereafter MSHWR). The Office of the Surgeon General produced this multi-part, multi-volume effort between 1870 and 1888 using the reports submitted by the army's medical officers during, and immediately following, the war. The Surgeon General's office collected this data with the intent not only of keeping track of the army's strength and needs as the war progressed, but also of using it for later statistical and clinical analysis, much as the British had done in their Medical and Surgical History of the British Army Which Served in Turkey and the Crimea During the War Against Russia, 1854-55-56.(1)

Finding that the existing reporting protocol was not precise enough, in May of 1862, Surgeon General William Hammond revised the forms that army medical officers used in order "to secure more detailed and exact reports of sick and wounded."(2) The next month, he announced that all of the data collected on the medical experiences of the Union would form the foundation for a post-war analysis—revealing his patriotic assumption that the North would triumph.(3) No doubt the war provided the Medical Department with an unparalleled opportunity to observe the patterns of morbidity and mortality then common to all armies encamped and on the move, to measure the carnage caused by contemporary weapons, and to compile accounts of the techniques—both successful and unsuccessful—that surgeons used to deal with the wounds of those who survived the battlefields. Acting Surgeon General Joseph Barnes, in November of 1863, advised that "the attention of all medical officers is earnestly directed to the importance of this subject [keeping reports]; without their cooperation, no reliable record can be preserved—the vast experience of the past will remain with individuals, and be lost to the service and the country." After reviewing the materials that had poured in by April of 1866, the Surgeon General's office made a case that the data they contained were "of immense value to the civilized world, and it seemed to be demanded that, in justice to humanity, and to the national credit, it should, at once, be made available by publication."(4) Congress agreed, and made suitable appropriations over the next two decades for the labor and materials for the work to proceed.(5)

The way that medical officers recorded information during the war meant that three overarching variables could be tracked for their influence on the kinds, and severity, of various diseases: geographical region, season, and race. "Motives of humanity," Joseph J. Woodward wrote in the introduction to Part I, Volume 1, "would seem to dictate that the statistics should be presented in the form most likely to render them serviceable as a contribution to our knowledge of the influence of race peculiarities on disease,"(6) noting, however, that "the returns afforded no available means for discrimination" between those of "mixed African and European blood" and those of obviously "white" and "colored" origins. The careful attention paid to keeping reports about the health of their white officers separate from the troops of "colored" regiments, means that the Surgeon General's office viewed the war as a major opportunity to collect data that might answer some questions about "race peculiarities" at the same time that battles raged over questions of emancipation and the effects of "race peculiarities" on the nation. As Margaret Humphries has shown, nineteenth-century statements about the comparative health of white and "colored" men based on Civil War data are hopelessly flawed due to the considerable differences in the quantity and quality of, among other staples, housing, food, and medical care.(7)

The first volume of the MSHWR is almost entirely comprised of tables of data about the diseases and injuries of the war, separated into sections for reports on the "white" and the "colored" troops in the Union army. The editors of the remaining five volumes arranged their books' contents by diseases and wound locations, further broken down into more refined categories. Thus, wounds from gunshots were distinguished from those from sabers, just as cases of acute dysentery with complications were distinguished from those of "simple inflammatory dysentery."(9) Additional chapters with narratives of, among other topics, the outcome of particular battles and the management of the wounded, the organization of the medical staff, and the use of anesthetics, supplement the accounts of specific diseases and injuries.

Table 1: Organization and coverage of the MSHWR.

Title page attribution

Source for

Date

Part I, Volume I

First Medical Volume

Prepared under the direction of Surgeon General Joseph K. Barnes

Statistical reports (no cases)

1870

Part I, Volume II

First Surgical Volume

Prepared under the direction of Surgeon General Joseph K. Barnes

Wounds of the head, face, neck, spine, and chest

1870

Part II, Volume I

Second Medical Volume

Prepared under the direction of Surgeon General Joseph K. Barnes by Joseph J. Woodward

Diarrhea and dysentery

1879

Part II, Volume II

Second Surgical Volume

Prepared under the direction of Surgeon General Joseph K. Barnes by George A. Otis

Wounds of the abdomen, pelvis, back, and upper extremity

1876

Part III, Volume I

Third Medical Volume

Prepared under the direction of the Surgeon General by Charles Smart

All other diseases

1888

Part III, Volume II

Third Surgical Volume

Prepared under the direction of Surgeon General Joseph K. Barnes by George A. Otis and D. L. Huntington

Wounds of the lower extremity, miscellaneous injuries

1883

In each topically-oriented volume (see Table 1), the authors of the MSHWR placed their discussions of Civil War experience into the context of contemporary medical knowledge, making extensive use of the growing library located in the Surgeon General's offices.(11) Each section organized around a particular aspect of a disease, or a type and location of wound, thus includes extensive footnotes to accounts in both military and civilian sources from a wide range of American and European origins.

Faced with mentions of hundreds of thousands of individual cases described in monthly reports, pocket field registers, accounts of surgical operations from the general hospitals, medical lists, bed cards, private correspondence, notes accompanying specimens sent to the Army Medical Museum, and pension records, the authors then had to decide which cases to include as exemplars of diseases, wounds, treatments, and operations. Many cases were noted in just a few lines and simply identified the condition and outcome, sometimes in a brief narrative and sometimes compiled into tables. In contrast, "the most interesting clinical histories have been printed in full," George Otis noted in his introduction to the first surgical volume.(12) Completeness of the record contributed to what made the case "interesting," as well, since some medical officers provided the bare minimum.

Otis went on to explain how the cases printed in the MSHWR were
constructed:

In stating in the abstracts that a case is reported by a medical officer whose name is given, it is not designed to intimate that he is responsible for the language employed. Very possibly some details are taken from several field or hospital reports or registers, each supplying some facts omitted in the others. It is simply designed to ascribe whatever merit belongs to the abstract to the surgeon giving the fullest account, or to give the history the authority of his name. Wherever the surgeon's own language is employed quotation marks are used, and whenever complete histories have been furnished by a single observer, they have been preferred, and printed in the reporter's own words.(13)

To the retrospective account from field and hospital reports, the authors added information gleaned from reports received about soldiers seeking pensions for disabilities arising from their wounds and diseases. These records were closely linked to those from the war, since the pension seeker had to establish that his sickness or injury took place during active Union service. These reports extended knowledge about the ways that diseases and wounds had long-term effects. While only a few years had elapsed when the volumes published in 1870 appeared, in the twenty-three years it took to compile Part 3, Volume 1, quite a bit of information had accrued about pensioners, including causes of death.

The cases included on this site are, as far as we have been able to determine, those of all of the soldiers who spent time in a hospital in the District of Columbia or Alexandria, whether they only passed through on the way to hospitals further north or settled in for a stay that might have lasted for months.(14) Even so, the cases featured in Civil War Washington present a very small subset of all of the cases detailed in the MSHWR; those, in turn, are but a subset of all of the cases of sickness or injury experienced during the war itself. This sample is neither a representative one, nor is it random. As Otis' description of how the cases were written for the project makes clear, moreover, the cases are by no means raw, real-time narratives of diseases and wounds. Many actually had multiple unknown authors, whose records of facts were absorbed into others' accounts to create coherent stories. The cases cannot serve, then, as either a sound sample for statistical analysis or as a way to discover "authentic" experience. They can, however, provide significant insights into the suffering and endurance of those who served in the Union army. These men suffered from diseases that are no longer familiar to us, and from wounds that, unfortunately, are. They offer us a way into understanding the nation's capital as a city of pain, as well as death, a city where the citizens were continually reminded of the human costs of the war.

Methodology

Susan C. Lawrence, Matthew M. Bosley, and Elizabeth Lorang

Civil War Washington staff obtained both scanned page images of the MSHWR volumes as PDFs and as plain-text files of the volumes' text derived via optical character recognition processes from the Internet Archive. We used the OCR text to search for and identify all cases that reference hospitals named in the Indexes to Field Records of Hospitals, "Alexandria" and "Washington and Georgetown, D.C." (NARA, Record Group 94). We then extracted all of these cases, and they make up the subset of cases from the MSHWR treated by Civil War Washington. Project staff and students in Susan C. Lawrence's classes manually corrected the OCR text retrieved from the Internet Archive. For this work, staff and students compared the OCR text with the page images. The text of each case is represented in an XML file and has been encoded according to the TEI Consortium's TEI P5: Guidelines for Electronic Text Encoding and Interchange.

We have encoded all person, place, and organization names as well as all dates. In some cases, we have simply flagged a name or a date, while in others we have provided a regularized version of a name or further described the date in the encoding. Work is ongoing to provide regularized versions of all names in the encoding, in order to enable linking between the cases and the project database and to facilitate deeper exploration of the materials presented throughout Civil War Washington. In addition, we have encoded keywords as part of each case. All of the medical and surgical keywords have been identified strictly according to the terms used in the nineteenth-century texts. The transcriptions presented on Civil War Washington preserve all errors present in the original text. In the case of typographical errors and idiosyncratic spellings, our encoding allows us to present both the incorrect or antiquated usage as present in the original as well as a corrected or regularized reading. A dashed line underneath a word cues users to those places where an alternative reading is available.

11. Pt. 1, V. 2, xx. This library became the nucleus for the National Library of Medicine. See Wyndham D. Miles, A History of the National Library of Medicine (Bethesda: U.S. Department of Health and Human Services, 1982). [back]

14. The work to present all of the DC and Alexandria cases on Civil War Washington is ongoing. Currently, we make available more than 1,400 cases. Future installments to this section of the site will bring the total number of cases to more than 2,000. [back]